Backboarding Obese Patients

LACoGurneyjockey

LACoGurneyjockey

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I ran into this issue the other day. Called for an MVA, find 2 patients complaining of neck and back pain, no deficits, no AMS or LOC. One of the patients is in the range of 400+ lbs.
Now, I know backboarding this patient likely will not cause them any benefit, but sometimes protocol ties out hands.
Does anyone have any special considerations when C-Spining obese patients. This situation was compounded by his being entrapped at a 90 degree angle. But even so, he's just too wide for the board. There's no spot for anyone to help carry from the sides, just the corners. And the board is bending under his weight, in a very disconcerting U shape. The collar at its largest setting is not even close to fitting the patient, and plenty of 2 inch tape is needed to secure the collar.
And to top it off, the local hospital has a CT machine with a 300lbs limit. So this patient either goes an 1 hr+ to the trauma center, is boarded and then cleared at the local hospital without
 
I'd call a doctor is what I'd do if you're really that tied by your protocol.

Also an improperly fitted cervical collar can actually manipulate the patients neck and thinking about the whole goal of backboarding that bending cause the "U" you talked about is definitely counterproductive as well as dangerous even if the idea behind backboards is flawed.

Maybe it's different here since you can't build a rapport with the physicians but here if I called and explained this situation to them they'd allow me to use alternate methods of immobilization.

Was he ambulatory? I'll see if I can find the source but allowing ambulatory patients to self extricate in a c-collar and walk to the gurney and then be transported supine. Granted you couldn't properly collar this guy but you can use towel rolls and tape and ingenuity in general to make it work.

Nice double post haha

Edit: triple post :beerchug:

Second edit: I think I see how that happened :lol:
 
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LACoGurneyjockey said:
I ran into this issue the other day. Called for an MVA, find 2 patients complaining of neck and back pain, no deficits, no AMS or LOC. One of the patients is in the range of 400+ lbs.
Now, I know backboarding this patient likely will not cause him any benefit, but sometimes protocol ties out hands.
Does anyone have any special considerations or suggestions when C-Spining obese patients. This situation was compounded by his being entrapped at a 90 degree angle. But even so, he's just too wide for the board. There's no spot for anyone to help carry from the sides, just the corners. And the board is bending under his weight in a very disconcerting U shape. The collar at its largest setting is not even close to fitting the patient, and plenty of 2 inch tape is needed to secure the collar.
And to top it off, the local hospital has a CT machine with a 300lbs limit. So this patient either goes an 1 hr+ to the trauma center, is boarded and then cleared at the local hospital without imaging, or you disregard a very clear protocol and do not backboard this patient.
What's the best solution to this fuster cluck of a situation?
Does anyone have any tricks to backboarding patients like this, much as I may hate doing it?
Click to expand...

what are your boards rated for?
was the pain from the accident or existing?

improvise...do what you can.
I would do everything in my power to clear cspine in the field so it wouldnt be an issue.
 
LACoGurneyjockey said:
Does anyone have any tricks to backboarding patients like this, much as I may hate doing it?
Click to expand...

Medical Control could help. As could a bariatric unit. Failing those, you could certainly do as the above poster suggested and collar --> pivot --> right onto the board which is already on the cot.
 
I'd be trying extra hard to rule out any of the Ottowa rules for c-spine, but depending on the type of MVA that could be a bit tricky. The others have said the rest. I have not clue what these boards are usually rated for, never really thought of it. I know bariatric units have their own set though, let alone a larger stretcher. That'd be my next move.
 
Grimes said:
I'd be trying extra hard to rule out any of the Ottowa rules for c-spine, but depending on the type of MVA that could be a bit tricky. The others have said the rest. I have not clue what these boards are usually rated for, never really thought of it. I know bariatric units have their own set though, let alone a larger stretcher. That'd be my next move.
Click to expand...



We follow a modified nexus/Canadian Cspine rule. If the pt was ambulatory at any time we wouldn't have to board them.
 
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LACoGurneyjockey said:
I ran into this issue the other day. Called for an MVA, find 2 patients complaining of neck and back pain, no deficits, no AMS or LOC. One of the patients is in the range of 400+ lbs.
Now, I know backboarding this patient likely will not cause them any benefit, but sometimes protocol ties out hands.
Does anyone have any special considerations when C-Spining obese patients. This situation was compounded by his being entrapped at a 90 degree angle. But even so, he's just too wide for the board. There's no spot for anyone to help carry from the sides, just the corners. And the board is bending under his weight, in a very disconcerting U shape. The collar at its largest setting is not even close to fitting the patient, and plenty of 2 inch tape is needed to secure the collar.
And to top it off, the local hospital has a CT machine with a 300lbs limit. So this patient either goes an 1 hr+ to the trauma center, is boarded and then cleared at the local hospital without
Click to expand...

If the collar doesn't fit you can always just use rolled up towels and support them that way. Also check out the product information sheet of your backboard to see how much they're able to hold.
 
Medic Tim said:
We follow a modified nexus/Canadian Cspine rule. If the pt was ambulatory at any time we wouldn't have to board them.
Click to expand...

http://www.wikiradiography.com/page/Ottawa+Rules

All of the above :P But yes, I mean for c-spine.

About not "having" to backboard them... eh. Perhaps you wouldn't "have" to. But I'd be checking every rule if the MOI called for it, whether they were ambulatory or not. Personally I've packaged two kiddos who walked off the football field before admitting or presenting S/S, and have heard too many stories of the same thing.
 
Mechanism by itself means pretty much nothing... One of the reasons I don't like a lot of the Cspine rule out protocols. I am on my companies protocol review committee and we are pushing I get rid of boards and going to c collar only immobilization.
We have all heard the horror stories of not boarding ppl but I doubt a quarter of them are true.... If a person actually did have a fracture... One of the worst things we can do is board them.. Unfortunately standard of care has not caught up to the evidence.

I am familiar with the Ottawa ankle and knee as I use them quite often... Never heard of the cdn Cspine rules referred to as the Ottawa Cspine rule before.
 
Grimes said:
http://www.wikiradiography.com/page/Ottawa+Rules

All of the above :P But yes, I mean for c-spine.

About not "having" to backboard them... eh. Perhaps you wouldn't "have" to. But I'd be checking every rule if the MOI called for it, whether they were ambulatory or not. Personally I've packaged two kiddos who walked off the football field before admitting or presenting S/S, and have heard too many stories of the same thing.
Click to expand...

And the obligatory MOI training aide:

http://youtu.be/0HAGMb_jAdU
 
Nice lol^^

Personally with a patient that big Id probably see if they can get themselves out and walk/move themselves to the stretcher. Too heavy for a board and if the collar doesn't fit it doesn't go on. I'll do what I can but when someone's that big a lot of equipment won't work. Hazard of being fat.

Second choice might be to use a scoop. They will still hang off the sides but it's metal and won't bend like a plastic board.
 
I know I am likely preaching to the choir here, but when will people realize that not only is obesity a threat to long term health from a life-expectancy standpoint / short term health from a quality of life standpoint, but can be DEADLY (excepting cardiac arrest) in an emergency scenario re extrication & mobility?

If a Pt has to wait on lift assist / special equipment due to their size and it exacerbates their condition due to injury, what is the recourse - it just totally breaks down from a logic-perspective for me.
 
It's a tough situation. Many services are adding equipment for bariatric patients, but it's been slow to come. In the meantime, using additional personnel helps to an extent, but you need to be careful with weight limits of equipment.
 
Could the entire seat be removed with the pt aboard, then addressed away from the rest of the car? Unbolt it, air chisel to cut the pillars, etc? Need to secure to seat before safety belts are cut. Sort of use the seat as the extrication device. Once 360 degree access is achieved, then move on to securing for transport. (Back seat=never mind, tear the car apart around the pt).

Tell us what the outcome was. Did your ambulance litter accept that weight? Was it big enough?

A bowing board means the board is a splint and not a flat hard tortuous litter.
 
I like the idea of taking him out on the seat, but it was an older model car wth one bench seat across the front, with the car tilted on it side so his 400lbs of weight is what's entrapped his wife, on the lower passenger side. Fire cut the doors and part of the roof off and we just got enough people around him to lift almost straight up onto the board.
Our gurneys are all rated between 600 and 750lbs, not sure on the boards but I'll try and find out. I'll have to try the rolled up towels for c-spine, in the past when a necks been too wide for the collar we've tried to line it up in the front and secure it the rest of the way with 2 inch tape.
And after all that, the local ER Doc didn't have a CT machine that he'd fit, and ended up clearing C-Spine without imaging (which I, being the lowly ambulance driver I am, would have liked to do in the first place...).
 
LACoGurneyjockey said:
I ran into this issue the other day. Called for an MVA, find 2 patients complaining of neck and back pain, no deficits, no AMS or LOC. One of the patients is in the range of 400+ lbs.
Now, I know backboarding this patient likely will not cause them any benefit, but sometimes protocol ties out hands.
Does anyone have any special considerations when C-Spining obese patients. This situation was compounded by his being entrapped at a 90 degree angle. But even so, he's just too wide for the board. There's no spot for anyone to help carry from the sides, just the corners. And the board is bending under his weight, in a very disconcerting U shape. The collar at its largest setting is not even close to fitting the patient, and plenty of 2 inch tape is needed to secure the collar.
And to top it off, the local hospital has a CT machine with a 300lbs limit. So this patient either goes an 1 hr+ to the trauma center, is boarded and then cleared at the local hospital without
Click to expand...

Due to the patients weight, placing him supine and attempting to collar his would result in SEVERE respiratory compromise and actually place the patient in further distress. Under our protocols we would be able to take this into account and not backboard him.

Place him on the cot seated and use a towel roll to provide neck stabilization
 
STXmedic said:
And the obligatory MOI training aide:

http://youtu.be/0HAGMb_jAdU
Click to expand...

What's hilarious is they showed us this same video in school one day :P It's the funniest those guys have made. Trust me, I understand where you're coming from. I'm not saying significant MOI = full package, I'm just saying it means we'll have the Pt very still while we talk and begin to rule out. If we clear c-spine, we clear c-spine.
 
I've played with using the towel a couple times. It actually felt surprisingly secure and was easier to turn the patient out and up.
 
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